Comparing Psychometric Properties of the NIH Toolbox Cognition Battery to Gold-Standard Measures in Socioeconomically Diverse Older Adults.

Abstract

The National Institutes of Health Toolbox-Cognition Battery (NIHTB-CB) is an efficient computerized neuropsychological battery. This study investigated its psychometric properties in terms of sociodemographic characteristics and technology use in adults aged 57-87 (with an average age of 70). Community-based participatory research procedures were used to enhance enrollment of adults with lower education and income backgrounds. Study procedures replicated work that compared the NIHTB-CB Crystallized and Fluid composites to analogous gold-standard (GS) measures and extended it by investigation of socioeconomic status and technology use-related differences in performance. The high correlations among the NIHTB-CB and GS analogous Crystallized and Fluid composites suggested good convergent validity. There was no evidence of significant education- or economic-related group differences in these associations. However, caution is needed as Cronbach's alpha that indicated the NIHTB-CB Fluid composite had questionable internal item consistency. The NIHTB-CB and GS measures demonstrated poor discriminant validity in the high school but not college-educated groups. Regression analyses found that comfort with technology use, income, education, and age predicted better cognitive test performance on the computerized and paper-pencil measures. There is an urgent need to improve the understanding of socioeconomic disparities influence on test scores and brain health. Lack of discriminant validity in the cognitive tests indicates that these measures could result in diagnostic errors within noncollege-educated older adults. These findings reduce confidence in the use of the NIHTB-CB Fluid composite in older adults and support that there is a significant socioeconomic-related digital divide in comfort with technology use.